Abstract | INTRODUCTION: Observational and randomized controlled trials of the combination of vancomycin or daptomycin with a beta-lactam (BL) in patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia have shown conflicting results on patient outcomes. OBJECTIVES: METHODS: A systematic literature search of PubMed, Embase, CINAHL, and meeting proceedings was conducted from inception through February 11, 2020, to identify relevant studies. The primary outcome was clinical failure and secondary outcomes were mortality, nephrotoxicity, and bacteremia. The meta-analysis was performed using Comprehensive Meta Analysis (version 3.0) with a random effects model. Outcomes were reported as odds ratios ( ORs) with corresponding 95% confidence intervals (CIs). RESULTS: Nine studies of 1636 patients receiving vancomycin or daptomycin monotherapy versus the combination of vancomycin or daptomycin plus BL for MRSA bacteremia were included. Results showed combination therapy was associated with significantly lower clinical failure rates (OR 0.56, 95% CI 0.39-0.79, I2 = 26.22%, p=0.001). Improvement in clinical failure was driven by lower rates of bacteremia relapse and persistence. However, no difference was seen with mortality. CONCLUSIONS:
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Authors | Pramodini B Kale-Pradhan, Christopher Giuliano, Annelise Jongekrijg, Michael J Rybak |
Journal | Pharmacotherapy
(Pharmacotherapy)
Vol. 40
Issue 7
Pg. 648-658
(07 2020)
ISSN: 1875-9114 [Electronic] United States |
PMID | 32533859
(Publication Type: Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural)
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Copyright | © 2020 Pharmacotherapy Publications, Inc. |
Chemical References |
- Anti-Bacterial Agents
- beta-Lactams
- Vancomycin
- Daptomycin
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Topics |
- Anti-Bacterial Agents
(administration & dosage, therapeutic use)
- Daptomycin
(administration & dosage, therapeutic use)
- Drug Therapy, Combination
- Humans
- Methicillin-Resistant Staphylococcus aureus
- Observational Studies as Topic
- Randomized Controlled Trials as Topic
- Staphylococcal Infections
(drug therapy)
- Treatment Outcome
- Vancomycin
(administration & dosage, therapeutic use)
- beta-Lactams
(administration & dosage, therapeutic use)
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